Rao Medha Sridhar, Gaur Aditya, Bharadwaj Hareesha Rishab, Imran Shahzeb, Tan Joecelyn Kirani, Abbas Saad, Fuad Muhtasim, Abuhashem Shadi, Shah Muhammad Hamza, Dalal Priyal, Al Khatib Abdulrahman Nasir, Abbasher Hussien Mohamed Ahmed Khabab
School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.
Yeovil District Hospital, Somerset NHS Foundation Trust, Higher Kingston, Yeovil, United Kingdom.
Ann Med Surg (Lond). 2025 Mar 7;87(4):2218-2228. doi: 10.1097/MS9.0000000000003141. eCollection 2025 Apr.
Pediatric gastroenterology (GI) care in low- and middle-income countries (LMICs) faces substantial challenges due to limited healthcare infrastructure, inadequate resources, and a shortage of specialized healthcare professionals. These challenges lead to delayed diagnoses and treatment, exacerbating the morbidity and mortality associated with pediatric GI diseases, which include both infectious conditions like diarrhea and chronic conditions such as inflammatory bowel disease (IBD) and liver diseases.
The aim of this review is to examine the current state of pediatric GI care in LMICs, identify the key challenges these regions face, and propose strategies to improve healthcare outcomes for children affected by GI disorders.
This review synthesizes existing literature from a range of LMICs, analyzing factors such as the economic burden of healthcare, barriers to access, the availability of diagnostic and therapeutic services, and the state of pediatric hepatology and endoscopy. Studies included in the review were sourced from countries in sub-Saharan Africa, South Asia, and other LMIC regions, focusing on pediatric GI disorders and healthcare delivery.
Economic burden: Families in LMICs face significant economic barriers in accessing pediatric GI care, with treatment costs often exceeding household income, especially in private healthcare settings. Healthcare access: Limited access to healthcare facilities, especially in rural areas, coupled with the shortage of trained pediatric gastroenterologists and necessary medical equipment, leads to delayed diagnoses and inadequate care for conditions like infections and chronic liver diseases. Sanitation and infectious diseases: Poor sanitation and lack of access to clean water contribute to the high prevalence of diarrheal diseases, which can be reduced through better hygiene practices and improved infrastructure. Training gaps: The shortage of trained healthcare workers, particularly pediatric specialists, hinders effective care delivery, with healthcare workers often overburdened due to workforce migration and low salaries. Hepatology and endoscopy: Pediatric hepatology, especially in the context of viral hepatitis, and the availability of pediatric GI endoscopy are severely limited in LMICs, further complicating the management of liver diseases and GI conditions in children.
Improving pediatric GI care in LMICs requires addressing systemic challenges such as inadequate healthcare infrastructure, limited financial resources, and a shortage of trained professionals. Prevention strategies like vaccination, sanitation improvements, and public health education campaigns are crucial for reducing the prevalence of pediatric GI diseases. In addition, enhancing access to specialized training, healthcare services, and diagnostic tools will improve outcomes for children in resource-limited settings. Continued international collaboration and investment in local healthcare systems are essential for creating sustainable solutions and bridging the gap in pediatric GI care.
由于医疗基础设施有限、资源不足以及专业医疗人员短缺，低收入和中等收入国家（LMICs）的儿科胃肠病学（GI）护理面临重大挑战。这些挑战导致诊断和治疗延迟，加剧了与儿科胃肠疾病相关的发病率和死亡率，这些疾病包括腹泻等感染性疾病以及炎症性肠病（IBD）和肝病等慢性病。
本综述的目的是研究LMICs中儿科胃肠病护理的现状，确定这些地区面临的关键挑战，并提出改善受胃肠疾病影响儿童医疗结果的策略。
本综述综合了来自一系列LMICs的现有文献，分析了诸如医疗保健的经济负担、获取障碍、诊断和治疗服务的可用性以及儿科肝病学和内窥镜检查的状况等因素。综述中纳入的研究来自撒哈拉以南非洲、南亚和其他LMIC地区的国家，重点关注儿科胃肠疾病和医疗服务提供。
经济负担：LMICs的家庭在获得儿科胃肠病护理方面面临重大经济障碍，治疗费用往往超过家庭收入，尤其是在私立医疗环境中。医疗保健获取：获得医疗设施的机会有限，尤其是在农村地区，再加上训练有素的儿科胃肠病学家和必要医疗设备的短缺，导致诊断延迟和对感染和慢性肝病等疾病的护理不足。卫生与传染病：卫生条件差和缺乏清洁水导致腹泻病高发，通过更好的卫生习惯和改善基础设施可以降低腹泻病发病率。培训差距：训练有素的医护人员短缺，尤其是儿科专科医生，阻碍了有效的医疗服务提供，由于劳动力迁移和低工资，医护人员往往负担过重。肝病学和内窥镜检查：在LMICs中，儿科肝病学，尤其是在病毒性肝炎方面，以及儿科胃肠内窥镜检查的可用性严重受限，这进一步使儿童肝病和胃肠疾病的管理复杂化。
改善LMICs中的儿科胃肠病护理需要应对系统性挑战，如医疗基础设施不足、财政资源有限和训练有素的专业人员短缺。疫苗接种、改善卫生条件和开展公共卫生教育运动等预防策略对于降低儿科胃肠疾病的发病率至关重要。此外，增加获得专业培训、医疗服务和诊断工具的机会将改善资源有限环境中儿童的医疗结果。持续的国际合作和对当地医疗系统的投资对于创造可持续解决方案和弥合儿科胃肠病护理差距至关重要。
